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Relevance. In accordance with Federal Law No. 323-FZ [17], emergency medical assistance, including emergency specialized medical care, is provided in emergency form outside a medical organization, as well as on outpatient and inpatient basis. An ambulance is an emergency medical service that travels to those whose lives and health are in danger. Emergency medical assistance, including emergency specialized medical care, is provided in case of diseases, accidents, injuries, poisonings and other conditions requiring urgent medical intervention. The reasons for calling an ambulance in an emergency form are sudden acute diseases (conditions) and (or) sudden exacerbations of chronic diseases without obvious signs of a threat to life, requiring urgent medical intervention. In the training of doctors, including in postgraduate education, these factors are taken into account.Aim of the study. Improvement of the quality of theoretical and practical training of emergency medical specialists, as well as clinical residents and practical doctors of various specialties, taking into account issues of emergency and military medicine.Material and methods. A review of official documents of the Ministry of Healthcare of the Russian Federation and the literature on postgraduate education of doctors with subsequent primary specialized accreditation for 2018-2022 was carried out. The literature on modern approaches to the provision of emergency medical care to victims was studied, taking into account the specifics of military (tactical) medicine for 2020–2022.Conclusion. The training of emergency medical professionals, taking into account the realities of the present, should include issues of tactical medicine and be practice-oriented using simulation equipment. It is necessary to know and be able to work with modern means of protection and medical care available in the troops; be prepared to work in medical institutions of various levels with the mass flow of injured and wounded.

At present, there is a tendency towards an increase in emotional problems everywhere, this especially affects the working-age population – relationships in a team, professional work process – all this leads to the development of production-related stress. Health care workers are at the forefront of risk of developing stress reactions and its consequences. This is most pronounced in the specialties providing emergency medical care, among employees of ambulance teams and departments of anesthesiology and resuscitation.The aim of the study was to conduct a comparative analysis of the psychophysiological state of emergency medical staff and departments of anesthesiology and resuscitation.Materials and methods. The study involved 67 people – employees of ambulance teams and resuscitation and intensive care units in Saratov. To obtain the necessary data, all participants filled out questionnaires – the PSM-25 psychological stress scale, the HADS hospital anxiety and depression scale, and the symptomatic questionnaire by A. Volkova and N. Vodopyanova.Results. When questioned using the PSM-25 scale, which assesses mental tension, it was found that more than half of the respondents have a high level of stress, while the indicator of mental tension among ambulance workers is statistically significantly higher than among employees of intensive care units and intensive care units. An analysis of the HADS ques tionnaire showed that the vast majority of respondents, both in ambulance teams and in intensive care units, have a high level of anxiety and depression. In the study using the symptomatic questionnaire A. Volkova and N. Vodopyanova noted a high predisposition to the development of pathological stress reactions in most of the respondents.Conclusion. Doctors in the specialties we study are characterized by long-term chronic stress, which can lead to the development of anxiety, depression, and pathological stress reactions. To avoid the occurrence of the conditions described above, it is important to adjust the work schedule of employees in time, to observe occupational and rest hygiene.

Introduction. Holding mass sports events of international level imposes a special responsibility on the medical services of the host city. The issues of organizing medical support for competitions are one of the foundations for the safety of all participants. By identifying different client groups, the organizers provide optimal conditions for each of them, this also applies to medical support.Aim. To describe the features of medical support in a life-threatening condition to a representative of one of the client groups of the 2018 FIFA World Cup in Samara.Material and methods. A clinical case of stroke that occurred during the 2018 FIFA World Cup in Samara is presented. The stages and timing of the provision of assistance, the interaction between the links of the medical service, the coordination of medical support are described, and the other factors that played a role in the outcome of the patient's disease are also reflected.Results. The fastest possible diagnosis and medical support at the prehospital stage led to the delivery of the patient to an authorized hospital and access to specialized medical care within the time frame envisaged by clinical protocols and recommendations. The inpatient stage of treatment with the use of high-tech methods of surgery and intensive care ended in a complete recovery of the patient. Conclusion. The described clinical case illustrates the expediency of the special requirements put forward to the medical support of major sports competitions. Competent operational planning, training of medical staff and their equipment, built inter- and intradepartmental interactions ensure the availability and quality of medical care, including in life-threatening conditions.

Introduction. At the stage of emergency medical care, the time of observation of a patient receiving antihypertensive therapy is limited to the time of stay of the emergency medical service team with this patient. Therefore, assessing the efficacy and safety of prescribing a particular antihypertensive treatment pattern is a relevant task. Patients and Methods. In this study, we used three two-component combinations of antihypertensive drugs (captopril and furosemide, moxonidine and furosemide, moxonidine and nifedipine) and prolonged blood pressure monitoring. We included 105 patients with a history of primary arterial hypertension who called an ambulance because of an increase in blood pressure and signed a voluntary informed consent. Evaluation of the results of prolonged blood pressure monitoring was carried out in 91 patients. The comorbidity, the clinical condition of the patient, blood pressure monitoring parameters, the efficacy and safety of antihypertensive therapy at the prehospital stage were evaluated. Results. The most pronounced and somewhat excessive hypotensive effect developed when using a combination of moxonidine with nifedipine. The index of excessive decrease in blood pressure below 120/70 mm Hg in this group was 51.6% (p

Introduction. The adaptive overload of the central nervous system, caused by occupational stress, leads to the disruption of complex operational activities in the ambulance station workers and an increasing number of errors in medical decision-making towards the end of the work shift.Aim. To assess the level and prevalence of changes in the work of the central nervous system (CNS) under the influence of occupational stress.Materials and methods. The study involved 35 workers (medical and nursing staff) of ambulance station (19 men and 16 women aged 20 to 55 years). Electroencephalogram (EEG) was recorded at rest for 3 minutes, according to international scheme 10-20 in six leads: F3, F4, T3, T4, P3, P4. The following rhythmic activity indicators were used: THETA rhythm (4–8 Hz), ALPHA rhythm (8–12 Hz), BETA rhythm (BETA, 12–25 Hz) and their ratios.Results and discussion. When analyzing the overall activity, there is a decrease in all the studied parameters. At the same time, THETA, BETA and the total power of all ranges showed significant dynamics. In spatial analysis, the most noticeable decrease in activity in the frontal lobes (F3, F4) is responsible for motor behavior (premotor area of the cortex), executive functions (behavior control, inductive reasoning, planning), short-term and spatial memory, attention (spatial and motor). The decrease in activity in the temporal (T3, T4) and parietal (P3, P4) departments is observed only in some indicators.Conclusions. Professional workload during the 24 hour shift has a predominant effect on the activity of the frontal lobes, reducing the ability to control and plan complex (precise) motor functions, visual-spatial attention and planning abilities. These mechanisms are key to the professional work of the personnel of the emergency medical service and determine the number of errors.

Objective: Analysis of cooperation between the Ministry of Emergency Situations (MChS) and Emergency Medical Services (EMS) personnel in the coordination of efforts to eliminate the consequences of road traffic accidents (RTA) in the city of Izhevsk, Udmurtia, Russia. Methods: 206 employees of the MChS of Izhevsk, who participated in road accident consequences elimination in 2018, were questioned. Data were extracted from 5052 MChS statistical forms «Card 1/RTA» from 2011 to 2017. Statistical analysis of the data included the calculation of extensive indicators, the weighted arithmetic mean, the calculation of the z-test, smoothing the time series using a moving average, the calculation of the growth rate using the SPSS 22 and Microsoft Excel 2010 statistical software package. The level of statistical significance was taken as p0.05). In 68.5% of cases, one ambulance team attended one victim; in 17.1% and 5.7%, two and three victims, respectively. However, there have been documented cases when one emergency team attended more than 4 casualties of road accidents. Conclusion: This study addressed one of the aspects of interdepartmental relations; however, some issues remain unresolved. In some cases, it was manifested in uncoordinated interactions between the EMS and the MChS: non-simultaneous arrival of representatives of two departments, insufficient number of emergency teams at the accident scene, incoherence between services at the accident scene.

COVID-19 infection causes many difficulties for the medical community around the world. In addition to its therapeutic problems, it can create situations with high medical and legal risks for a doctor who has a certain medical responsibility in preventing the spread of infection in a pandemic. In fact, this new infection imposes many specific obligations on all medical organizations and, first of all, on the Emergency medical service. In the present article, we analyzed in chronological order the orders and instructions issued in the context of the COVID-19 epidemic in St. Petersburg, and studied the dynamics of measures used to prevent the spread of infection and to protect health workers as the urgency and complexity of the situation increase. The first experience of ambulance doctors in the context of the COVID-19 pandemic showed the need to comply with all prescribed measures of individual and collective protection to minimize infection transmission and prevent medical and legal risks

Atrial fibrillation (AF) is the most common heart rhythm disorder with clinical and social significance. The expected increase in the incidence of AF and the high financial costs that occur in the treatment of these patients require a more detailed study of the epidemiological situation on AF in our country. The article provides data on the appeal for emergency medical care (EMC) of patients with AF in St. Petersburg, Gatchina, Sestroretsk, Great Novgorod. The analysis revealed significant seasonal variations in the number of EMC calls: a decrease in the treatment of EMC patients with AF in the summer in St. Petersburg. Gender-age differences were revealed, the general increase in the circulation of elderly and senile women with AF for EMC in St. Petersburg and Leningrad region. In different regions of our country, there are significant differences in statistical accounting methods used in emergency medical facilities. However, in order to obtain full information on the spread of AF, it is advisable to develop uniform statistical methods of accounting (registers) for this group of patients.

Objectives to develop the main strategies of emergency medical care improvement for patients with acute coronary syndrome, in order to reduce the morbidity and mortality in the population of a large industrial region. Material and methods.The study was conducted on the basis of the Moscow regional ambulance station. We used the content analysis, logical, system analysis, the method of mathematical statistics. Results.In the period 20172018, in the region's population, there is a tendency for decrease in the number of calls for ambulance teams caused by acute coronary syndrome. During the analyzed period, we noticed the reduction of the number of cases of pre-hospital thrombolytic therapy (by 17.5%). The response time to the patient's call not more than 20minutes was observed in 92.9% of cases, the number of lethal outcomes in presence of the ambulance team decreased by 4.6%. The results can be explained by the dynamic development of the infrastructure of cities and districts of the Moscow Region, by the improvement of road networks, by the complete renewal of the service's motor vehicle fleet, and by the opening of a number of new specialized medical institutions. A set of medical and organizational measures has been developed and put into practice in the ambulance service of the region, aimed at further improvement of the system of ambulance care for patients with acute coronary syndrome at the prehospital stage. Conclusion.The mortality reduction, preservation and improvement of public health can be achieved only through the comprehensive sustainable development of the regions infrastructure, improvement of the organizational structure of the emergency medical service, mandatory use of algorithms and standards for the provision of medical care to patients at all stages.

Objective: Improvement of the model of the automated control system to support the decision-making in the field of emergency medical care to the population of a large industrial center. Methods: The analysis of the activity of the ambulance station was studied the existing normative legal acts regulating the activity of emergency medical aid. A detailed study of software KGBUZ «KSSMP» – an automated control system (ASU) «MISS 03», working system of dispatching of vehicles – «AutoGRAPH». To create a model of its own software, the C++ programming language was used. Results: The model of the AnScor+ software and hardware complex created by us is organized as a distributed client-server system. The end devices are data collection terminals (mobile phones of ambulance crews running the Android operating system); a client-server Android application was developed for them. The interaction between mobile terminals, dispatcher terminals, and the MISS-03 automated control system is carried out centrally through the software of the AnScor+ server. Conclusion: The creation of such analytical services to ensure the solutions of the problems of transport logistics, automated patient flow management will allow realizing in practice the advanced algorithms of the medical emergency services, significantly improve the main performance indicators, such as the promptness of quality and the volume of medical care.

In 163 patients we compared the therapeutic efficacy and safety of a single sublingual original moxonidine (Fiziotenz, Abbott) and generic moxonidine (Tenzotran, Actavis Group) in the provision of emergency medical services in the case of high blood pressure. It was found that the original moxonidine (Fiziotenz) and generic moxonidine (Tenzotran) are effective to provide emergency medical services with an increase in blood pressure, especially in patients with hypersympathicotonia. At the same time, generic Tenzotran lowers blood pressure less and later than Fiziotenz, the original drug. Adverse effects after using both drugs were not expressed and rare.

Оказание муниципальных услуг населению в условиях реформ в сфере здравоохранения является одним из важных вопросов. Исследования показали достаточно высокий уровень востребованности среди населения услуг скорой медицинской помощи. Именно данный вид медицинской услуги является одним из дорогостоящих и является одним из видов муниципальной услуги населению. В связи с этим остро стоит вопрос в подготовке кадров как для медицинских услуг населению, так и в управленческом аппарате. Здравоохранение, являясь важной отраслью народного хозяйства, призвано обеспечивать реализацию важнейших государственных гарантий – это охрана, сохранение и улучшение здоровья граждан Российской Федерации, оказание им высококвалифицированной лечебно-профилактической помощи.В настоящее время сложившаяся система организации скорой медицинской помощи населению, ориентированная на оказание пациентам максимального объема помощи на догоспитальном этапе, не обеспечивает необходимой эффективности.Все это свидетельствует о необходимости совершенствования службы скорой медицинской помощи. Основными ее задачами на современном этапе должны являться оказание больным и пострадавшим догоспитальной медицинской помощи, направленной на сохранение и поддержание жизненно важных функций организма, и доставка пациентов в кратчайшие сроки в стационар для оказания квалифицированной и специализированной медицинской помощи. Основным направлением в совершенствовании организации оказания СМП является разработка приоритетных организационных технологий, позволяющих эффективно внедрять современные методы реализации всего комплекса догоспитальной помощи с целью максимального удовлетворения потребностей населения при условии рационального использования ресурсов здравоохранения.Среди современных проблем обеспечения качественного оказания смп в рамках национального проекта «здоровье» приоритетное место отведено разработке и совершенствованию стандартов в осуществлении лечебно-диагностического процесса, материально-технической оснащенности и правовому регулированию деятельности службы.Изучение организационных технологий и их роли в предоставлении такой муниципальной услуги, как «скорая медицинская помощь» в условиях крупного города делает актуальным настоящее исследование.

The article presents some results of an in-depth sociological study of doctors and nurses in the emergency hospital. In the research process the opinion about peculiarities of the organization of work at the ambulance hospital department was studied, Kaliningrad.